Provider Demographics
NPI:1831139138
Name:MYERS, MICHAEL C (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5289
Mailing Address - Fax:740-446-5697
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5289
Practice Address - Fax:740-446-5697
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14162085R0202X
OH34-00-56822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001714061OtherMOUNTAIN STATE BCBS
WV0119559000Medicaid
000000007369OtherANTHEM BCBS
OH0929179OtherMOLINA MEDICAID
300032014OtherRR MEDICARE
OH000000191101OtherUNISON MEDICAID
300032014OtherRR MEDICARE
OH000000191101OtherUNISON MEDICAID
F59776Medicare UPIN
WV0741605Medicare PIN